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Detecting donor-specific antibodies: the importance of sorting the wheat from the chaff
- Publication Year :
- 2019
- Publisher :
- AME Publishing Company, 2019.
-
Abstract
- Human leukocyte antigen (HLA) compatibility is very important for successful transplantation of solid organs. In this paper, we focused on the humoral arm of immunity in the clinical setting of organ transplantation: how HLA antibodies develop, how they can be detected, and what they can do to injure organ transplants. Specifically, we explore the technical perspectives of detecting donor-specific antibodies (DSA) in HLA laboratories, and use real-life clinical cases to explain the principles. Currently there are many tools in our HLA antibody detection toolbox: conventional cytotoxicity cross match, flow cross match, and solid phase assays using beads conjugated with single or multiple HLA antigens. Single antigen bead (SAB) assay is the most sensitive tool available for detecting HLA antibodies and assessing the immunological risk for organ transplant. However, there are intrinsic limitations to solid-phase assays and they are prone to both false negativity and importantly, false positivity. Denatured antigens on single antigen beads might be the most prominent source of false positive reactivity, and may have been underestimated by many HLA experts. No single assay is perfect and therefore multiple methods, including the less sensitive assays, should be employed to determine the clinical relevance of detected HLA antibodies. Thoughtful process, including knowledge of HLA systems, cross reactivity, epitopes, and the patient’s clinical history should be employed to correctly interpret data. The clinical team should work closely with HLA laboratories to ensure accurate interpretation of information and optimal management of patients before and after organ transplantation.
- Subjects :
- medicine.medical_specialty
biology
business.industry
Human leukocyte antigen
030230 surgery
medicine.disease_cause
Cross-reactivity
Organ transplantation
Epitope
Transplantation
03 medical and health sciences
0302 clinical medicine
Antigen
Immunology
biology.protein
Medicine
Clinical significance
Antibody
business
Special Issue: Antibodies and Liver Transplantation, Guest-Edited by Prof. Vivian McAlister
030215 immunology
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....7f3d7320192bf668b5707b9dcf84c317